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Table 4 Immediate issues in the care of chronic heavy drinkers admitted to the hospital

From: Care for hospitalized patients with unhealthy alcohol use: a narrative review

Clinical issue Treatment
Assess risk for nutritional deficiency • Thiamine supplementation.
• Possibly folate and multivitamin supplement.
Assess hydration status and electrolytes (risk for hypocalcemia and hypomagnesemia with or without hypokalemia and hypophosphatemia) • IV or oral fluids.
• Oral or IV electrolyte replacement.
Risk for acute alcohol withdrawal • Close observation with validated instrument or prophylactic benzodiazepine, particularly in those with previous withdrawals or history of severe withdrawal (delirium tremens or seizure).
• Prophylaxis still requires close observation for over or under-sedation.
Active alcohol withdrawal • Symptom-triggered or scheduled benzodiazepine.
• Close observation with validated instrument with either symptom-triggered or scheduled dosing.
• Alternate medication (e.g., phenobarbital) in rare event that benzodiazepine is unsuccessful at controlling agitation.
• Possible beta blocker or clonidine for autonomic manifestations if benzodiazepine alone is insufficient.
• Possible haloperidol if benzodiazepine alone is insufficient for delirium.
  • Consider other causes of delirium.